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23 Oct 2007 : Column 6WH—continued
Salford’s population is predicted to increase, and with it both the number of older people and their proportion within the population will also increase. The population is projected to increase from 215,000 in 2008 to 218,300 in 2025, and all my comments relate to those dates. During that period, the number of people who are 65-plus will increase from 33,200, or 15.44 per cent. of the population, to 37,400, or 17.13 per cent. The number of over-85s will increase from 4,300, or 2 per cent., to 5,500, or 2.52 per cent. Some may not think those figures important, but the figures represent a staggering increase of nearly 30 per cent. in our 85-plus population. The picture is similar for older middle-aged people.
Ian Stewart: The Minister has one of the most important briefs in Government. I have said that the matter is serious, but it is good to see that he has a sense of humour, notwithstanding that his comment from a sedentary position was based on fact.
The picture is similar for older middle-aged people, the percentage of whom within the population is projected to increase by 11.5 per cent. by 2025. The statistics might be dry, but they have clear implications for health and social care provision, as most needs increase with age, such as the need for sensory equipment, home care, residential care and so on. One in four people over 80 are estimated to have dementia. An ageing population will mean a shift in the type of provision needed and in the staff skills needed to deliver such care. Conversely, the number and proportion of younger adults in Salford is decreasing, which has implications for the availability of potential carers. We must pay particular attention to that. Some characteristics of an older population must be addressed.
Mr. Bill Olner (in the Chair): Order. Will the hon. Gentleman please bring his comments to a conclusion in order to allow others to speak?
Ian Stewart: Mr. Olner, the statistical approach is dry, but I assure you that it is important to recognise that the change in nature of our population and its needs is happening so fast and will have such an impact that the nub of the matter must be addressed.
I welcome the announcement by my right hon. Friend the Secretary of State for Health that we will receive an extra £2.6 billion. That is welcome, but we should accept that the current settlement system is unfair and that it works against those councils with residents in most need. We in Salford wish to build on the enhanced relationship with Departments and on the excellent progress made by the city council, but we need a fairer funding system.
I accept that the Minister is sincere in his passion to do better in his brief for residents across the United Kingdom, but I hope that he recognises that the system is not yet right. I hope that the forthcoming three-year funding settlement recognises that councils such as Salford wish to deliver the services needed by families in the area in a fair way. We need to ensure that the words “social justice” mean something. I know that the Minister
wishes to do that, and I hope that he and the Secretary of State will ensure that the funding system is made fairer during the three-year settlement.
10 am
Sir George Young (North-West Hampshire) (Con): It is a pleasure to follow the hon. Member for Eccles (Ian Stewart), who spoke movingly about the challenges that confront his constituents. His constituency could not be more different from mine; his is an inner-city seat in the north and I have a rural seat in the south. However, the fact that we both face the same problems makes the case that the Minister needs to answer even more powerful.
I congratulate my parliamentary neighbour, the hon. Member for Romsey (Sandra Gidley), on securing this timely debate, as it is in the shadow of comprehensive spending review 2007. For some reason, the CSR will not be debated in the House—instead, we have rather more fragmented debates in Westminster Hall—but it sets the parameter for social services expenditure over the next three years.
More than half of those hon. Members who are here took part in a similar debate earlier this year in the context of residential care. Everyone who spoke in that debate made the point that social services were under extreme pressure. The right hon. Member for Oxford, East (Mr. Smith) said of this “complex and crucial” area of care that it was
“under enormous pressure because of demand and constraints on resources even as they are increasing.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 316WH.]
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) spoke about the problems in residential care, and my hon. Friend the Member for Eddisbury (Mr. O'Brien) spoke about the absence of a long-term strategy for funding care, a subject to which he may want to return.
In that debate, I asked for a step increase in funding for social services to eliminate its historical underfunding and a realistic baseline to be provided from which we could move forward. In his reply, the Minister—I welcome him again this morning—gently rebuked us for not noticing in the last pre-Budget report that
“the Treasury identified social care as one of the great challenges facing this country and one that we have an obligation to address.”
He went on to reassure us that
“We are arguing forcefully—I shall not reveal the details in this debate—with the Treasury about the importance of a good settlement for social care under the comprehensive spending review.”
“We need a new deal to reflect a new settlement in the demographic realities of the 21st century.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 332-32WH.]
He was right. This morning, we have an opportunity to assess the Minister’s performance, as set out in CSR2007, against those statements.
The average real-terms increase in public spending over the next three years in the comprehensive spending review is 2.1 per cent. Against that benchmark, who are the winners and who are the losers? The biggest loser is local government, at 1 per cent., narrowly below the
Home Office at 1.1 per cent. No way is that a good settlement. No way is that the new deal that the Minister held out earlier this year.
The third biggest winner, after the Department for International Development and the Cabinet Office, which are both small Departments, was NHS England. That disparity in treatment under the Government between health and social services underlines my point. Although the NHS has had a 90 per cent. increase in funding since 1997, if schools are exempted—they are now directly funded by the Government—local government has received only 14 per cent., and the largest service provided by local government is social services.
I understand the political imperatives. Ministers have direct responsibility for the NHS, whereas social services fall to local councillors. How tempting it must be for Ministers to pre-empt for themselves the lion’s share of the CSR for the services for which they are accountable and let councillors take the rap for social services. It is understandable, but it is wrong. The extra 1 per cent. for the NHS, announced with a flourish by the Chancellor a fortnight ago, should, if one believes in joined-up government, have gone to the under-funded social service authorities rather than the NHS.
Ian Stewart: Does the right hon. Gentleman not accept that his comments, pointed as they are, would be more pertinent if we were starting from now? All the statistics that I and others have cited have been built up over the past 30 years. It is important to recognise that.
Sir George Young: I am grateful to the hon. Gentleman, who may have made a valid point. He might like to consider what happened from 1992 to 1997, and see whether there was a disparity then in the treatment of the two. I hope, in return, that he will extend the gentle criticism that I have made of his Administration, that there has been a disparity—in my view, an indefensible disparity—since 1997. Even the 4 per cent. comprehensive spending review increase for the NHS is aimed much more at hospitals than at assisting the NHS to move resources into the community. Had it been the other way around, one could have had a greater partnership with the county councils, who know the communities and have good links with them.
The Government have allowed adult services a growth of 1 per cent., but they expect councillors to increase direct payments, to invest in prevention so that people can remain independent, and to phase out the use of NHS accommodation for people with learning disabilities and to help them live independently in the community. Adult social services are struggling to cope with their current responsibilities. It seems a Herculean task to respond genuinely to the challenges that the Government have laid before them with such resources.
The Minister must know what is going to happen. As the hon. Member for Romsey said, eligibility thresholds will have to be raised, care will be rationed for the most vulnerable, preventive work will be cut back, and charges will be increased or introduced—and the council tax will take the strain. If the Minister believes that health and social services are key partners in the welfare state, he will know that they need to be given roughly comparable resources. If one needs help, one is not interested in whether it comes from social services or health; one
simply wants the services to which one is entitled. Policy for the past 20 years has focused on breaking down the barriers between the two—promoting joint commissioning, joint assessment, and the rest. If they are to be key partners, they must be more equal. They both need to bring something to the table.
I shall pass over the demographic clock that is ticking in Hampshire, as it is in Eccles and elsewhere—the needs of young adults with learning disabilities coming up from children’s services demanding and expecting large care packages, and parents with offspring with a learning disability who themselves are ageing.
Consultation is about to begin on the Green Paper. It will, of course, be important, as it will offer a potential overhaul of the funding of social care. However, it will not help during the next three years of the spending review. No additional resources have been added to help with the demographic pressure and the other pressures that are on adult services nationally. My county council will get less grant than others, because it is a floor authority; it will have to make economies in other services and raise the council tax to make up the difference.
I leave the Minister with a final question. Is that it? Will there be, at some point during this Parliament, an opportunity to revisit the three-year settlement announced for social services, so that we can get them a squarer deal?
10.9 am
Dr. Richard Taylor (Wyre Forest) (Ind): I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. It is highly significant that we have heard from right hon. and hon. Members from the north and the south; we are now bang in the middle—the midlands.
I regard such debates as an opportunity to pass on advice to Ministers. I may not have a major party to make firm plans, but I like to think that what I say is taken seriously and that it remains in their brains for the future. My interest in the subject was kindled by a meeting with the chief executive of Worcestershire county council not all that long ago, when he made the stark statement that funding social care was the major problem now facing county councils. He went on to provide some of the figures purely for Worcestershire for people who are supported to live at home. The figures from 2002-03 to 2005-06 for learning difficulties, mental health, physical disability and older people have increased by 17 per cent. In 2005-06, 12 young people were moving to adult care; in 2006-07 there were 39 and in 2007-08 there are 43.
Other hon. Members mentioned an increase in the population over 65—in my county, a 14 per cent. increase over the next five years—and talked about the reasons for that, such as increasing longevity, the complexity of problems that it brings, including an increase in disability and dementia, and the fact that young people with serious illnesses can be kept alive longer.
Hon. Members who have been around for some time, like me, will remember that NHS hospitals 20 and 30 years ago were full of long-stay beds. Quite rightly, with innovative geriatricians, long-stay beds have been cut back dramatically, but shutting those beds has passed the problem from health to social care. The Select Committee on Health report on NHS continuing care,
in the parliamentary Session of 2004-05, drew attention to that in one of its recommendations when it said:
“long term care responsibilities of the NHS have reduced substantially, and people who in the past would have been cared for in NHS long stay wards are now...accommodated in nursing homes”,
which meant that there had been a shunting of the work without the funds.
Other hon. Members referred to the inequitable investment between health and social care. Although one welcomes tremendously the increase in health funding, that makes it more difficult for social services, because an increased throughput in the NHS is likely to increase the work load on social services as well.
Economies that my county council are putting in place hit older people in particular. Staffing is reduced, and the terrible vacancy factor effectively reduces staff. Things like meals on wheels and rapid response teams are being attacked. One specific example of that is the cessation of in-house benefits advice, which is being passed to citizens advice bureaux. The local authority is ceasing to pay the CAB for specialist mental health advice. That matter was brought to my attention in one of my surgeries by a mental health advice worker who pleaded on the part of one of her cases. She was speaking about an illiterate elderly gentleman looking after a schizophrenic wife at home. He could not understand the benefits and finances that he was allowed and was only managing because of the advice from this dedicated worker who will now be removed. The CAB will be lumbered with all this extra work.
I want to say a word on the Health Committee report on NHS continuing care. It contains a lot of clear recommendations, and I am delighted that one of those is that there should be clarity about NHS continuing care and NHS-funded nursing care. The national framework certainly addresses that, but, sadly, there has been no change as far as we can see in the Government’s thinking about the unification of health and social care. One comment in the summary of the Health Committee report said:
“The artificial barriers between health and social care lie at the heart of the problems surrounding access to continuing care funding. It will be impossible to resolve these problems without first establishing a fully integrated health and social care system.”
At that time, the Government kicked that firmly into touch and responded as follows:
“The divide between health and social care provision, and the basis on which it is provided, has stood since 1948. To dismantle this would be a fundamental and costly change to the structure of the welfare state, which would go well beyond the scope of this inquiry.”
The Government seem to be pretty good at reorganising the health service and I would like to think that this matter will be mentioned in the Green Paper because it would make a huge difference.
We must continue to look for economies. I was delighted when the Secretary of State for Health remarked in one statement that the NHS better care, better value indicators were already producing some economies. The Disability Rights Commission feels that direct payments would be more efficient and better. With the health and social care regulator coming together, links forming across health and social care, and public health doctors being shared between health and social care, surely there is a move towards combining these things.
Finally, if one were to address health care rationing, which lots of people would like us to do, many people would think that cradle-to-grave care is one thing that should be funded, if we can make the economies on some of the unnecessary things by cutting them out with rationing.
10.17 am
Mr. Graham Stuart (Beverley and Holderness) (Con): It is a pleasure to discuss the funding of social care, which we did as recently as January. Many hon. Members who are in the Chamber today spoke then, as my right hon. Friend the Member for North-West Hampshire (Sir George Young) said. He put his finger on the central point, which is ensuring that the Government deliver on social care in the way that the Minister promised he would in January. It is worth repeating his words then, because I hope that he will address the matter. He said that he would be
“arguing forcefully”
“the importance of a good settlement for social care under the comprehensive spending review.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 331WH.]
The question today, which has come from hon. Members from all parties, is whether a comprehensive spending review settlement that sees increases in social care spending that are actually a full 50 per cent. below the average across all government spending, as my right hon. Friend pointed out, and a full 3 per cent. less than the real increase in health care, in any way constitutes a decent and proper settlement for social care, given the pressures itemised by so many hon. Members today and on previous occasions. That is the nub of the issue, which I hope the Minister will address. I do not believe that that is a decent settlement.
My right hon. Friend made a persuasive argument as to why Ministers would separate social care, which is not their direct responsibility, from health care, which is, leading to a grossly disproportionate settlement on each despite the pressures on social care spending.
Mr. Ivan Lewis indicated dissent.
Mr. Stuart: If the Minister would like to intervene, I would be happy to give way. He is normally quick to do so.
Mr. Bill Olner (in the Chair): Order. If the Minister intervenes, that would give him less time to respond.
Mr. Stuart: It would indeed. As I said, I hope that the Minister will consider that.
Mr. Lewis: Will the hon. Gentleman give way?
Mr. Stuart: The Minister has got his thoughts together.
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